Efficient workflow for afib treatment in the ep lab

ABSTRACT

A system and method relate to enhanced medical workflows. Current anatomical data of a patient may be acquired, such as via a computed tomography or magnetic resonance procedure, just before and/or during an intervention. During the intervention, an electroanatomical map of the patient may be generated. The electroanatomical map may be generated from three-dimensional ultrasound data acquired via a medical device. The current anatomical data and electroanatomical map may be dynamically fused during the intervention. The fused data may be displayed and/or used to localize a current position of the medical device in real-time. The medical device may be a catheter employing a multi-dimensional forward-looking array of sensors. In one aspect, the enhanced workflow may be associated with an ablation procedure or other intervention performed in an electrophysiology lab. The use of current anatomical data and more accurate multi-dimensional ultrasound data may alleviate inefficiencies and inaccuracies associated with conventional interventions.

BACKGROUND

The present embodiments relate generally to the medical treatment ofpatients. More particularly, the present embodiments relate to enhancedmedical workflows and devices used during interventional medicalprocedures.

Conventional medical workflows may be cumbersome, inefficient, and/orcostly. Some workflows may take up to six hours or more. As an example,medical workflows related to the field of electrophysiology (EP) mayinvolve electroanatomical (EA) mapping and the registration of the EAmap with anatomical data. The anatomical data may be acquired frompre-interventional computed tomography (CT) or magnetic resonance (MR)individual procedures, which may be time consuming. Theelectroanatomical mapping itself may require additional time, as well asa dedicated mapping catheter having position sensors integrated into thecatheter, such as commercially available carto systems from BiosenseWebster.™

Yet, the registration, or integration, of the anatomical map (acquiredvia CT or MR procedures) with the EA map may be inaccurate. Inaccuraciesmay arise due to the conventional anatomical data not being up-to-date.The pre-interventional CT/MR scan may have been taken days or weeksbefore. As a result, conventional anatomical data used during anintervention may not represent the actual, current status of thepatient.

Additionally, conventional mapping catheters may not provide foradequate localization of the catheter tip. Therefore, another source oferrors associated with the registration of EA maps with anatomical datamay be an intrinsic error associated with catheter localization.

BRIEF SUMMARY

A system and method relate to enhanced medical workflows and devices.The workflow may involve, as part of an interventional medicalprocedure, (1) acquiring current anatomical data of a patient, and (2)generating an electroanatomical (EA) map of the patient. The anatomicaldata may be acquired via a computed tomography, magnetic resonance, orother medical imaging procedure. The EA map may be generated from dataacquired using a medical device, such as three-dimensional ultrasounddata. The anatomical data may be dynamically fused or integrated withthe EA map during the intervention. As a result, the fused image datamay be displayed and/or used to automatically or visually accuratelylocalize the medical device in real-time during the intervention. In oneaspect, the medical device may be an enhanced catheter employing amulti-dimensional looking array of ultrasound sensors. In anotheraspect, the workflow may be associated with an ablation procedureperformed within an electrophysiology (EP) lab. Using current anatomicaldata in conjunction with more accurate multi-dimensional ultrasound dataduring an intervention may alleviate inefficiencies and inaccuraciesassociated with conventional workflows.

In one embodiment, a medical method for assisting, with a system, aninterventional procedure is provided. The method includes, as part ofthe interventional medical procedure, (1) acquiring current anatomicaldata of a patient via a medical imaging device; (2) generating a currentelectroanatomical map of the patient; (3) dynamically fusing the currentanatomical data with the current electroanatomical map; and (4)displaying fused images associated with the fusion of the currentanatomical data with the current electroanatomical map in real-time suchthat the fused images displayed facilitate completion of theinterventional medical procedure.

In another embodiment, a medical method for assisting, with a system, aninterventional procedure is provided. The method includes acquiringcurrent anatomical data of a patient, as part of an interventionalprocedure, when the patient is on a medical table; generating anelectroanatomical map of the patient using data acquired from a medicaldevice inserted into the patient during the interventional procedure;dynamically fusing the current anatomical data and the electroanatomicalmap to create composite images; localizing a position of the medicaldevice within the patient in relation to the composite images; anddisplaying the composite images associated with the fused currentanatomical data and the electroanatomical map such that the localizedposition of the medical device within the patient during theinterventional procedure may be ascertained.

In another embodiment, a data processing system facilitates ainterventional workflow. The system includes a processing unit that (1)receives current anatomical data of a patient; (2) receivesmulti-dimensional ultrasound data acquired using a medical deviceinserted into the patient; (3) dynamically integrates the currentanatomical data with the multi-dimensional ultrasound data to facilitatelocalization of a position of the medical device internal to thepatient; and (4) visually depicts the localized position of the medicaldevice internal to the patient on a display.

In yet another embodiment, a computer-readable medium providesinstructions executable on a computer. The instructions direct receivingcurrent three-dimensional computed tomography data; receiving real-timethree-dimensional ultrasound data acquired via a medical device duringan intervention; dynamically fusing the real-time three-dimensionalultrasound data with the current three-dimensional computed tomographydata during the intervention to localize a current position of themedical device within a patient; and displaying the current position ofthe medical device in relation to an anatomical structure of thepatient.

Advantages will become more apparent to those skilled in the art fromthe following description of the preferred embodiments which have beenshown and described by way of illustration. As will be realized, thesystem and method are capable of other and different embodiments, andtheir details are capable of modification in various respects.Accordingly, the drawings and description are to be regarded asillustrative in nature and not as restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates an exemplary medical workflow;

FIG. 2 illustrates another exemplary medical workflow;

FIG. 3 illustrates an exemplary catheter with a multi-dimensional arrayof sensors; and

FIG. 4 illustrates an exemplary data processor configured or adapted toprovide the functionality associated with the medical workflowsdiscussed herein.

DETAILED DESCRIPTION

The embodiments described herein include methods, processes,apparatuses, instructions, or systems related to enhanced medicalworkflows. The workflows may (1) acquire current anatomical data as apatient is on an operating table for an interventional medicalprocedure, and (2) generate an electroanatomical (EA) map of a portionof the patient via during the intervention. The EA map may be generatedfrom data acquired using a medical device inserted into the patientduring the intervention. Subsequently, (3) the anatomical data may bedynamically fused/integrated with the EA map in real-time or withminimum time delay. The fused data may be displayed and/or used toautomatically or manually accurately localize a position of the medicaldevice or a portion thereof within the patient during the intervention.

In one aspect, the workflow may be associated with an a-fib or otherablation procedure performed in an electrophysiology (EP) lab.Anatomical data may be acquired in the EP lab via computed tomography,magnetic resonance, or other medical imaging procedures. The EA map maybe generated from ultrasound or other data. In one embodiment, theanatomical data may be cardiac computed tomography data acquired using aC-arm based angiography system and the ultrasound data may be acquiredusing an enhanced catheter employing a multi-dimensional and/or forwardlooking array of ultrasound sensors or emitters.

In sum, the present embodiments may use current anatomical data inconjunction with a more accurate EA map (based upon multi-dimensionalultrasound data) to alleviate inefficiencies and inaccuracies associatedwith conventional medical workflows. As a result, the presentembodiments may shorten conventional interventional workflows, eliminateunnecessary procedures, alleviate inconveniences to the patient, enhancesafety, improve operational success rates, and/or reduce costs.

I. Ablation Procedures

In general, electricity normally flows throughout the heart in a regularpattern to facilitate heart muscle contractions. However, sometimes theelectrical flow gets interrupted, disturbing normal heart rhythms. Onetype of treatment for heart rhythm disorders is called ablation.

Cardiac ablation may be used to treat rapid heartbeats that begin in theupper chambers, or atria, of the heart. Specific types of heart rhythmdisorders include supraventricular tachycardias, atrial fibrillation,atrial flutter, AV nodal reentrant tachycardia, AV reentranttachycardia, or atrial tachycardia.

With atrial fibrillation (a-fib), the upper part of the heart beats morerapidly than the rest of the heart. The top part of the heart may quiverrapidly and irregularly (fibrillate) hundreds of times a minute.

Less frequently, ablation may be used to treat heart rhythm disordersassociated with the heart's lower chambers, known as the ventricles. Forinstance, ventricular tachycardia may cause sudden cardiac death.

Nowadays, an ablation procedure may be relatively non-invasive andperformed in an electrophysiology (EP) lab. The procedure may involveinserting a catheter into a blood vessel of the patient and guiding thecatheter via a narrow, flexible guide wire into the heart. The cathetermay be guided from the entry point into the patient to the heart usingimages created by a fluoroscope (x-ray related device) that providescontinuous images of the catheter.

Once the catheter reaches the heart, electrodes near the tip of thecatheter may gather data and a variety of electrical measurements may becalculated. The measurements may be used to identify where the faultyelectrical site is located within the heart. This process is referred toas “electrical mapping.” Once the problematic area is located, damagedtissue may be destroyed to eliminate the electrical disturbance.

II. Exemplary EP Lab

The present embodiments may involve acquiring current anatomical datafor real-time integration with ultrasound data or otherelectroanatomical mapping data. In one embodiment, a modified EP lab maybe operable to obtain CT data via a C-arm system, perform 3Dechocardiography, dynamically fuse the 3D anatomical data with the 3Decho data, and provide for the real-time detection and/or calculation ofthe location of a medical device, such as catheter, within the patientusing the 3D echo data.

Conventionally, the planning of procedures such as atrial fibrillationablations may have been based upon CT or MR images acquired before theexamination or intervention. However, morphologic information of thesepre-procedural images may be limited by the time lag to the actualintervention. The pre-procedural approach may not account for dynamicchanges that develop in the anatomical structures with time. The presentembodiments may permit cross-sectional images to be acquired in the EPlab during real-time or almost real-time to guide the intervention.

For example, cross-sectional CT images may be acquired in the EP lab asan initial step of an ablation or other intervention. Compared topre-procedural CT or MR images, the CT images may be used to visualizethe anatomy of the patient's left atrium in its actual state during theintervention. As a result, reliable orientation of images of thepatient's anatomy during the intervention may be facilitated.Additionally, the patient may be spared the inconvenience of having toundergo a separate imaging procedure.

In one aspect, the workflow may involve electrocardiogram (ECG)triggered rotational angiography and retrospective gatedthree-dimensional reconstruction. The ECG triggering of the temporalimage resolution may permit enhanced visualization of the movingstructures in multiple dimensions. The EP lab also may be associatedwith one or more user interfaces that provide access to and displayDICOM (Digital Imaging and Communications in Medicine) information.

An efficient and complete workflow may be performed within a modified EPlab. In one embodiment, the EP lab may facilitate a workflow thatincludes (1) the use of Cardiac Dyna CT™ (currently undergoing clinicalevaluations) or other medical equipment to obtain CT or otherthree-dimensional (3D) anatomical data sets of the patient's anatomywhen the patient is on a medical table within the EP lab; (2) the use of3D ultrasound data (such as echocardiography data), which may beintra-cardiac echocardiography (ICE) or extra-corporal data (such astransthoracic echocardiogram (TTE) or transesophageal echocardiogram(TEE) data); and (3) registration/fusion of the 3D anatomical data andthe 3D echocardiography data. Algorithms for this type of 3D data/3Ddata fusion are known to software and programming experts within thefield of image processing.

The EP lab may facilitate a workflow that also includes (4) the use ofreal-time 3D echocardiography to localize a catheter, particularly thetip of the catheter for EA mapping; (5) miniaturized ultrasoundmicroprocessor based probes or sensors (preferably, silicon basedsensors) mounted on the catheter; and (6) through the registration ofthe EA map with the anatomical data, determining and displaying thelocalized position of the catheter (tip) relative to the CT or otheranatomical data. The use of current anatomical data and/or more accurateultrasound data may enhance the accuracy of the localized position ofthe catheter determined and displayed as compared to conventionalworkflows. The workflow may further include (7) measuring an EA map ofthe atrium that may be related to the CT or other anatomical data; (8)during an ablation procedure, determining the location of the catheteragain from real-time 3D echocardiography data and relating the currentlocation of the catheter to the patient's anatomy and the EA map; and(9) performing ablations in the EP lab based on only anatomical orelectroanatomical data, or a combination of the two.

The workflow steps identified above are representative, but notexclusive. Other variants and combinations may be used. As a result, theworkflow may include additional, fewer, or alternate steps.Additionally, the workflow may not be limited to ablation procedures.The workflow may be a cardiac related workflow, such as a valvereplacement, or an abdomen, liver, cancer, or tumor related procedure,and/or another medical workflow.

Therefore, the present workflows may combine real-time anatomical data,with three-dimensional ultrasound data and catheter location data, andmeasure electrical signals for the heart. The anatomical data may befused with the ultrasound data in real-time during the intervention,such as to accurately represent the current position of the catheter tipwithin the patient. The workflow may involve combining x-ray anatomicaldata, which provides a global view, with ultrasound data, which providesa more limited field of view, such as a real-time localized view.

In a preferred embodiment, a method and system may acquirethree-dimensional images of a patient's anatomy, such as via DynaCT™ orother imaging systems. The three-dimensional anatomical images may bedynamically fused with real-time three-dimensional ultrasound images.The real-time three-dimensional ultrasound may be used to detect andlocalize a medical device within a patient during an intervention. Thedevice detected using an ultrasound technique may be depicted relativeto the three-dimensional anatomical images. In one aspect, the medicaldevice is a mapping catheter (“EP”). The mapping catheter may facilitatethe generation of an EA map solely from the measured electricalpotential and the known location, without the aid of any otherlocalization sensors.

III. Exemplary Workflow

FIG. 1 illustrates an exemplary workflow. The workflow 100 may include,during or as a part of an intervention, acquiring current anatomicaldata of a patient 102, generating an electroanatomical map of thepatient 104, dynamically fusing the current anatomical data and theelectroanatomical map to create fused images 106, localizing a medicaldevice in relation to the fused images 108, and updating the currentposition of the medical device during the intervention 110. The workflowmay include additional, fewer, or alternate steps.

The workflow 100 may include acquiring current anatomical data of apatient 102. The anatomical data may be acquired as part of aninterventional procedure, such as when the patient is on a medical tableat the initial stages of the procedure or during the procedure. Forexample, the anatomical data may be acquired either just before orduring the intervention. The anatomical data also may be updated duringthe intervention.

A number of imaging procedures may be used to acquire the anatomicaldata. The medical imaging equipment, preferably located within or nearthe modified EP lab, may relate to processing images illustrating anenhanced region of interest within a patient. For example, various typesof contrast medium may be administered to a medical patient. Thecontrast mediums enhance the scans acquired by scanning a patient orimages of the patient, the scans and images may be recorded by anexternal recording device as enhancement data. The contrast mediumtypically travels through a portion of the body, such as in the bloodstream, and reaches an area that medical personnel are interested inanalyzing. While the contrast medium is traveling through or collectedwithin a region of interest, a series of scans or images of the regionof interest of the patient may be recorded for processing and display bysoftware applications. The enhanced region of interest may show thebrain, the abdomen, the heart, the liver, a lung, a breast, the head, alimb or any other body area.

The image data may be generated by one or more specific type of imageprocesses that are used to produce the images or scans of the patient.In general, the types of imaging processes performed by the medicalequipment being used to produce patient images or scans of internalregions of interest include radiography, angioplasty, computerizedtomography, ultrasound and magnetic resonance imaging (MRI). Additionaltypes of imaging processes may performed by the medical equipment, suchas perfusion and diffusion weighted MRI, cardiac computed tomography,computerized axial tomographic scan, electron-beam computed tomography,radionuclide imaging, radionuclide angiography, single photon emissioncomputed tomography (SPECT), cardiac positron emission tomography (PET),digital cardiac angiography (DSA), and digital subtraction angiography(DSA). Alternate imaging processes may be used.

The workflow 100 may include generating an EA map of the patient 104.The EA map may be generated using data acquired from a medical deviceinserted into the patient during the intervention. The medical devicemay be a catheter, such as a catheter having a multi-dimensional arrayof ultrasound sensors as disclosed herein. Other exemplary cathetersthat may be used are disclosed by U.S. Pat. Nos. 5,947,905 and5,771,895, which are both incorporated herein by reference in theirentireties. Other medical devices may be used, such as modified wiresand needles.

The electrical mapping may be performed using a procedure referred to asechocardiography, such as 3D echocardiography. 3D echocardiography maybe based upon 2D techniques and use the same types of tools. By trackingthe size, shape, and position of heart structures in dozens of imagingplanes aligned in three dimensions via common reference points, theentire heart may be reconstructed as a solid object with accuraterepresentation of its shape. Known techniques for 3D echocardiographymay model the left and right ventricles, the left and right atria, andother portions of the heart. Other organs, such as the liver, as well asmuscles and vessels may be modeled. From the reconstruction ofanatomical structures, 3D echocardiography may allow medical personnelto ascertain the size and shape of the structures, and the spatialrelationships between them. Other electrical mapping procedures may beused.

In one aspect, generating the EA map may be accomplished as part ofultrasound imaging technique. Exemplary methods of ultrasound imagingand image reconstruction are disclosed by U.S. Pat. Nos. 5,787,889;5,934,288; and 6,139,500, which are all incorporated herein by referencein their entireties. Other imaging techniques may be used.

The workflow 100 may include dynamically fusing the current anatomicaldata and the EA map 106. The fusion of the current anatomical data andthe EA map may create composite images. The fusion may be accomplishedby techniques known to programming experts in the field. The compositeimages created may be used to localize the position of the medicaldevice within the patient. In one aspect, the fusion of the currentanatomical data and the EA mapping data may be accomplished using acommon coordinate system. The position of the medical device may then belocalized with respect to the common coordinate system. An exemplaryfusion technique is disclosed by U.S. Pat. No. 6,019,724, which isincorporated herein by reference in its entirety. Other fusiontechniques may be used.

The workflow 100 may include localizing a medical device in the fusedimages 108. The localization of the medical device may be performedautomatically by a processor. For instance, a processor may be able tocalculate a localized position of the medical device in relation toeither the anatomical date or EA map, or a combination of the two. Thecalculation may be done with more precision than conventional techniquesas the anatomical data of the present embodiments is more current and/oraccurate. Moreover, the electroanatomical data may be more accurate ifacquired with the enhanced catheters or other medical devices asdescribed herein. As noted above, the position of the medical device maybe localized with respect to a common coordinate system of the fusedimages. Other automatic localization techniques may be used.

By displaying the composite images of the fused current anatomical dataand the electroanatomical map with a visual depiction, outline, or anactual or virtual image of the medical device, medical personnel maythen be able to visually ascertain or localize the position of themedical device in relation to the patient's anatomy, with images of thepatient's anatomy being reproduced on the display from the anatomicaldata.

In one aspect, the composite images may be a fusion of solely theanatomical data and the EA map. A visual depiction of the medical devicemay then be superimposed upon the registration of the EA map withanatomical image data by a processor. Alternatively, the compositeimages themselves may include a visual depiction, either actual orvirtual, of the medical device. Either manner permits localization ofthe medical device and/or display of a localized position of the medicaldevice in relation to one or more anatomical structures of the patient.

The workflow 100 may include updating the current position of themedical device displayed during the intervention 110. As noted above,the composite images displayed may show or be altered to show alocalized position of the medical device within the patient during theinterventional procedure. As the intervention progresses, the localizedposition of the medical device may be recalculated, such as with respectto the common coordinate system. As a result, medical personnel may bepresented with a more accurate localization of the current position ofthe medical device internal to the patient in real-time during theintervention.

For instance, a visual depiction of the medical device may be moved onthe display to new and updated coordinates to display the medical devicein relation to the fused or composite images depicting the registrationof the EA map with the anatomical data. Alternatively, the fused orcomposite images may be altered. The current position of the medicaldevice being displayed may be updated in other manners.

FIG. 2 illustrates another exemplary workflow 200. The workflow 200 mayinclude acquiring current 3D CT image data via a C-arm based system 202,acquiring 3D ultrasound data via a catheter having a multi-dimensionalarray of sensors 204, fusing the current 3D CT image data with the 3Dultrasound data 206, localizing a position of the catheter internal tothe patient 208, displaying the localized position of the catheter inrelation to the fused images 210, and recalculating the current positionof the catheter during the intervention and updating the display toreflect the recalculated current position of the catheter 212. Theworkflow may include additional, fewer, or alternate actions.

IV. Exemplary Catheter

The present embodiments also relate to an enhanced ultrasound catheterwith a forward-orientated field of view. Typical endovascularinterventions may be performed using radiation. Contrast agent may beinjected selectively to make the vessels of interest visible. However, adisadvantage may be that only the open lumen of the vessel is shown. Asa result, the nature of the vessel wall may only be assessed indirectly.

To overcome this disadvantage, intravascular ultrasound (IVUS) may beemployed. Optical methods, such as OCT (optical coherence tomography)have also been tried in the clinical research field. A disadvantage ofthese methods may be that the radiation is emitted perpendicular to thetip of the catheter. This may result in acquiring data associated withonly a “slice” of the vessel wall at the point of the catheter tip.

The present embodiments provide an enhanced medical device operable toacquire a more complete and forward-looking image. For instance, themedical device, if used during an endovascular or other intervention,may provide the physician with a view forward of the endoscope. Thenature of the vessel wall (calcification, fibrous plaques, lipid plaque,etc.) in front of the medical device, such as a catheter or guide wire,may be shown on a display.

Although conventional optical angioscopy was an attempt at improvingimages displayed, it did not prove overly useful for the currentapplications as light (visible or infrared) cannot penetrate throughblood. Therefore, optical angioscopy may require rinsing the vessel tobe free of blood, for instance with physiological saline solution.Accordingly, the practical application of optical angioscopy may beoverly inconvenient and involve too many complications.

On the other hand, ultrasound does not have the limitations associatedwith optical angioscopy as ultrasound may easily “look” through blood.The most recent developments based on semiconductors (sometimes referredto as ultrasound on silicon) may produce miniature ultrasound emittersand receivers with highly variable geometries. The enhanced medicaldevices discussed herein may attach the tiniest ultrasound probes at thetip of the catheter along its circumference (such as shown in FIG. 3) oron its nose. In one embodiment, the individual ultrasound emittersfunction as forward-pointing sound wedges. By targeted electronictriggering of the individual silicon elements, the shape and range ofthe ultrasound field may be varied and adjusted. Additionally, usingvirtual histology, such as that produced by equipment available fromVolcano Corporation™, it is now known that the backscattered ultrasoundsignals may be processed in such a way to differentiate among thevarious plaques on the vessel walls.

FIG. 3 shows an exemplary enhanced catheter 300. The catheter 300 mayinclude a long, slender body 302, an internal lumen 304, and an array ofultrasound emitters 306. The catheter may include additional, fewer, oralternate components.

The catheter 300 may include a long and narrow body 302, such as thoseknown in the art. The internal lumen 304 may be used to house a guidewire. The guide wire may be used to navigate the catheter 300 internalto the patient during the intervention.

The array 306 may include a number of ultrasound emitters and/orsensors. The array 306 may be a multi-dimensional array, “looking” in anumber of directions. The array 306 may be positioned on thecircumference of the catheter 300, such as near the distal end.Alternatively, the array 306 may be positioned on the tip or forwardmost point of the catheter 300 itself. The array 306 may includeultrasound sensors encompassing a rounded forward tip of the catheter300 and further extending to encompass a portion of the roundedcircumference of the longitudinal body of the catheter 300. Otherarrangements may be used.

In one aspect, the array 306 may be a multi-dimensional forward lookingarray mounted on the tip or the body of the catheter. The array 306 maygather data as the catheter is advanced into the patient. In oneembodiment, the array 306 may comprise a plurality of sensors arrangedsimilar to a sonar dome on the bow of a ship or submarine. Of course,the sensors themselves would be much smaller in size to accommodatemedical applications, instead of nautical uses. Other geometries andarrangements of ultrasound sensors may be used.

The ultrasound catheter 300 shown in FIG. 3 may have a hollow lumenthrough which a thin guide wire can be advanced. In practical use, theforward-oriented ultrasound imaging may be used to control theadvancement of the guide wire relative to the vessel wall and topossible lesions.

In one aspect, the ultrasound catheter may be used during a medicalapplication directed toward the reopening of chronic total occlusions(CTOs). The ultrasound catheter may be advanced as far as the proximalend of the occlusion. The ultrasound image may show the user thecomposition of the thrombus (soft/hard or calcified) and any openmicro-channels that may be present. The guide wire may then be advancedin a targeted way through the soft plaque components or through themicroscopic channels.

In another aspect, the guide wire may be navigated magnetically. Bymagnetically navigating the guide wire, the method may be furtherautomated. From the ultrasound image, the point where the advancement ofthe wire is easiest and involves the least risk may be identified. Theextreme magnetic field may be adjusted such that the tip of the guidewire is steered into that point. An incremental advancement may then beperformed manually or automatically. The process may be repeated untilthe occlusion has been pierced completely.

The catheter tip may have a known and characteristic form. As a result,the catheter may be visually or graphically modeled to enhance theimages displayed. The characteristic form of the catheter tip mayprovide for a definite allocation of the catheter within the ultrasoundimage.

The catheter of FIG. 3 also may include a sensor system, such as asensor system for measuring electrical signals from the heart. A cartosensor on the tip of the catheter device may record signals for mappingthe medical device onto the anatomy of the patient. With the ultrasoundcatheter, monitoring may be performed in real-time without exposing thepatient to ionizing radiation.

V. Exemplary Data Processing System

FIG. 4 illustrates an exemplary data processor 410 configured or adaptedto provide the functionality for the workflows as discussed herein. Thedata processor 410 may be located at a central location, such as withinor near an EP lab. The data processor may include a central processingunit (CPU) 420, a memory 432, a storage device 436, a data input device438, and a display 440. The processor 410 also may have an externaloutput device 442, which may be a display, a monitor, a printer or acommunications port. The processor 410 may be a personal computer, workstation, PACS station, or other medical imaging system. The processor410 may be interconnected to a network 444, such as an intranet, theInternet, or an intranet connected to the Internet. The processor 410may be interconnected to a customer system or a remote location via thenetwork 444. The data processor 410 is provided for descriptive purposesand is not intended to limit the scope of the present system. Theprocessor may have additional, fewer, or alternate components.

A program 434 may reside on the memory 432 and include one or moresequences of executable code or coded instructions that are executed bythe CPU 420. The program 434 may be loaded into the memory 432 from thestorage device 436. The CPU 420 may execute one or more sequences ofinstructions of the program 434 to process data. Data may be input tothe data processor 410 with the data input device 438 and/or receivedfrom the network 444 or customer system. The program 434 may interfacethe data input device 438 and/or the network 444 or customer system forthe input of data. Data processed by the data processor 410 may beprovided as an output to the display 440, the external output device442, the network 444, the customer system, and/or stored in a database.

The program 434 and other data may be stored on or read frommachine-readable medium, including secondary storage devices such ashard disks, floppy disks, CD-ROMS, and DVDs; electromagnetic signals; orother forms of machine readable medium, either currently known or laterdeveloped. The program 434, memory 432, and other data may comprise andstore a database related to medical images of the patient.

The data processor 410 may be operable to acquire current anatomicaldata, such as data acquired via a C-arm imaging system, generate an EAmap, and fuse the current anatomical data with the EA map. For instance,the data processor 410 may (1) receive current anatomical data of apatient; (2) receive multi-dimensional ultrasound data acquired using amedical device inserted into the patient; (3) dynamically integrate thecurrent anatomical data with the multi-dimensional ultrasound data tofacilitate localization of a position of the medical device internal tothe patient; and (4) visually depict the localized position of themedical device internal to the patient on a display.

The program or other software associated with the data processor systemmay include instructions that direct the fusion of anatomical data withan EA map to create composite images and localizing a medical devicebeing used during an intervention within the composite images. In oneaspect, the instructions may direct receiving current three-dimensionalcomputed tomography data; receiving real-time three-dimensionalultrasound data acquired via a medical device during an intervention;dynamically fusing the real-time three-dimensional ultrasound data withthe current three-dimensional computed tomography data during theintervention to localize a current position of the medical device withina patient; and displaying the current position of the medical device inrelation to an anatomical structure of the patient.

The data processor 410 may facilitate an interventional workflow asdiscussed herein. The data processor 410 may provide functionalityrelated to standard x-ray fluoroscopy and carto systems, as well asaccept data from sensors integrated into a tip of a catheter or othermedical device. The data processor 410 may generate an EA map as thecatheter is advanced within a patient and measure the local potential.

The data processor 410 also may perform three-dimensional reconstructionof anatomical structures and provide rotational imaging for navigatingthe catheter within a patient. The navigation may be facilitated by trueand accurate representation of the anatomical structure(s).Additionally, the data processor 410 may display the representation ofthe anatomical structure in real-time or dynamically, such as when thecatheter is inside of the left atrium of the patient. In other words,the data processor 410 may combine real-time ultrasound image data withupdated anatomical data to create an up-to-date integrated display. Theup-to-date integrated display may facilitate the navigation of medicaldevices within the patient.

The data processor 410 may combine 2D or 3D ultrasound data with volumeand image anatomical data dynamically acquired or stored in a memory.For instance, the ultrasound data may be provided with a “slice” orspecific view of the patient. If the ultrasound data is combined withvolume information, accurate localization of the catheter or othermedical instrument may be facilitated.

In sum, as discussed elsewhere herein, in a preferred embodiment, amethod and system may acquire three-dimensional images of a patient'sanatomy, such as via DynaCT™ or other imaging systems. Thethree-dimensional anatomical images may be dynamically fused withreal-time three-dimensional ultrasound images. The real-timethree-dimensional ultrasound may be used to detect and localize amedical device within a patient during an intervention. The devicedetected using an ultrasound technique may be depicted relative to thethree-dimensional anatomical images. In one aspect, the medical deviceis a mapping catheter (“EP”) such that an EA map may be generated fromthe measured electrical potential and the known location, without anyother localization sensors (e.g., Carto™ system of Biosense Webster™).

While the preferred embodiments of the invention have been described, itshould be understood that the invention is not so limited andmodifications may be made without departing from the invention. Thescope of the invention is defined by the appended claims, and alldevices that come within the meaning of the claims, either literally orby equivalence, are intended to be embraced therein.

It is therefore intended that the foregoing detailed description beregarded as illustrative rather than limiting, and that it be understoodthat it is the following claims, including all equivalents, that areintended to define the spirit and scope of this invention.

1. A medical method for assisting, with a system, an interventionalprocedure, the method comprising: as part of the interventional medicalprocedure: (1) acquiring current anatomical data of a patient via amedical imaging device; (2) generating a current electroanatomical mapof the patient; (3) dynamically fusing the current anatomical data withthe current electroanatomical map; and (4) displaying fused imagesassociated with the fusion of the current anatomical data with thecurrent electroanatomical map in real-time such that the fused imagesdisplayed facilitate completion of the interventional medical procedure.2. The method of claim 1, the medical imaging device being a C-armcomputed tomography imaging device.
 3. The method of claim 1, theelectroanatomical map being generated from three-dimensional ultrasounddata.
 4. The method of claim 1, the electroanatomical map beinggenerated from an intra-cardiac or extra-corporal data set.
 5. Themethod of claim 1, the workflow further comprising using the fusedimages to localize a tip of a catheter internal to the patient duringthe interventional medical procedure.
 6. The method of claim 1, thecurrent electroanatomical map being generated from multi-dimensionalultrasound data acquired by a catheter inserted into the patient duringthe interventional medical procedure, the catheter acquires themulti-dimensional ultrasound data using a multi-dimensional lookingarray of ultrasound sensors.
 7. The method of claim 1, the workflowcomprising: displaying a depiction of a medical device used to generatethe electroanatomical map in relation to the fused images; and duringthe interventional medical procedure, recalculating a current positionof the medical device and updating the display of the fused images toillustrate the current position of the medical device internal to thepatient.
 8. The method of claim 1, the interventional medical procedurebeing an ablation procedure.
 9. A medical method for assisting, with asystem, an interventional procedure, the method comprising: acquiringcurrent anatomical data of a patient, as part of an interventionalprocedure, when the patient is on a medical table; generating anelectroanatomical map of the patient using data acquired from a medicaldevice inserted into the patient during the interventional procedure;dynamically fusing the current anatomical data and the electroanatomicalmap to create composite images; localizing a position of the medicaldevice within the patient in relation to the composite images; anddisplaying the composite images associated with the fused currentanatomical data and the electroanatomical map such that the localizedposition of the medical device within the patient during theinterventional procedure may be ascertained.
 10. The method of claim 9,the interventional procedure being an ablation procedure and the medicaldevice being a mapping catheter that facilitates the generation of theelectroanatomical map from the measured electrical potential and theknown location of the medical device without the aid of additionallocalization sensors.
 11. The method of claim 9, the current anatomicaldata comprising cardiac computed tomography data acquired using a C-armbased system.
 12. The method of claim 9, the electroanatomical map beinggenerated from multi-dimensional ultrasound data acquired via themedical device, the medical device being a catheter.
 13. The method ofclaim 12, the catheter having a multi-dimensional looking array ofultrasound sensors.
 14. The method of claim 13, the multi-dimensionalultrasound data is intra-cardiac or extra-corporal data.
 15. The methodof claim 9, the workflow comprising: recalculating a current position ofthe medical device during the interventional procedure; and dynamicallyaltering the composite images to display the current position of themedical device.
 16. A data processing system for facilitating aninterventional procedure, the system comprising: a processing unit that(1) receives current anatomical data of a patient; (2) receivesmulti-dimensional ultrasound data acquired using a medical deviceinserted into the patient; (3) dynamically integrates the currentanatomical data with the multi-dimensional ultrasound data to facilitatelocalization of a position of the medical device internal to thepatient; and (4) visually depicts the localized position of the medicaldevice internal to the patient on a display.
 17. The system of claim 16,the anatomical data being computed tomography data.
 18. The system ofclaim 16, the medical device being a catheter having a multi-dimensionalforward-looking array of sensors.
 19. The system of claim 16, theprocessor updating the localized position of the medical device beingdisplayed in real-time as the medical device is moved within thepatient.
 20. A computer-readable medium having instructions executableon a computer stored thereon, the instructions comprising: receivingcurrent three-dimensional computed tomography data; receiving real-timethree-dimensional ultrasound data acquired via a medical device duringan intervention; dynamically fusing the real-time three-dimensionalultrasound data with the current three-dimensional computed tomographydata during the intervention to localize a current position of themedical device within a patient; and displaying the current position ofthe medical device in relation to an anatomical structure of thepatient.
 21. The computer-readable medium of claim 20, the medicaldevice being a catheter having a multi-dimensional array of ultrasoundsensors.